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***In addition to urine and saliva, CMV can also be passed through other body fluids, such as blood, tears, semen, and breast milk.
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Most women of childbearing age don’t know about CMV and that they should not kiss their toddlers around the mouth or share food, cups and utensils with them. According to the Centers for Disease Control and Prevention (CDC), “Most people infected with CMV show no signs or symptoms. That’s because a healthy person’s immune system usually keeps the virus from causing illness. However, CMV infection can cause serious health problems for people with weakened immune systems and for unborn babies (congenital CMV).” Congenital CMV (cCMV) can cause hearing and vision loss, developmental delays, microcephaly and seizures.
The CDC provides a fact sheet of prevention tips. “The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” ("Congenital CMV Facts for Pregnant Women and Parents" flyer at: cdc.gov/cmv).
The CDC states: “About one out of every 200 infants is born with congenital cytomegalovirus (CMV) infection. However, only about one in five babies born with congenital CMV infection will have long-term health problems. A pregnant woman can pass CMV to her fetus following primary infection, reinfection with a different CMV strain, or reactivation of a previous infection during pregnancy." Congenital CMV is estimated to disable 4,000 babies every year in the U.S. (4 million annual births/200 with 1/5 sick or long-term health problems = 4,000 disabled by cCMV).
Toddlers can spread CMV to each other, their child care providers and families. On average, 30-40% of preschoolers in day care excrete CMV in their saliva and/or urine (Red Book: 2015 Report of the Committee on Infectious Diseases, American Academy of Pediatrics (AAP), p. 144). "Up to 70% of children ages 1 to 3 years in group care settings excrete the virus,” states AAP et al. in Caring for Our Children, the book used as a standard for child care centers in the U.S.
Women at higher risk for CMV include:
Parents with children in group care
Ways CMV can be transmitted:
According to the CDC, people with CMV may pass the virus in body fluids, such as saliva, urine, blood, tears, semen, and breast milk. CMV is spread from an infected person in the following ways:
The CDC provides a fact sheet of prevention tips. “The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” ("Congenital CMV Facts for Pregnant Women and Parents" flyer at: cdc.gov/cmv).
The CDC states: “About one out of every 200 infants is born with congenital cytomegalovirus (CMV) infection. However, only about one in five babies born with congenital CMV infection will have long-term health problems. A pregnant woman can pass CMV to her fetus following primary infection, reinfection with a different CMV strain, or reactivation of a previous infection during pregnancy." Congenital CMV is estimated to disable 4,000 babies every year in the U.S. (4 million annual births/200 with 1/5 sick or long-term health problems = 4,000 disabled by cCMV).
Toddlers can spread CMV to each other, their child care providers and families. On average, 30-40% of preschoolers in day care excrete CMV in their saliva and/or urine (Red Book: 2015 Report of the Committee on Infectious Diseases, American Academy of Pediatrics (AAP), p. 144). "Up to 70% of children ages 1 to 3 years in group care settings excrete the virus,” states AAP et al. in Caring for Our Children, the book used as a standard for child care centers in the U.S.
Women at higher risk for CMV include:
Parents with children in group care
- “Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018).
- "Parents of children attending day-care centers” are at increased risk for contracting CMV (Pass et al, 1986).
Ways CMV can be transmitted:
According to the CDC, people with CMV may pass the virus in body fluids, such as saliva, urine, blood, tears, semen, and breast milk. CMV is spread from an infected person in the following ways:
- From direct contact with saliva or urine, especially from babies and young children
- Through sexual contact
- From breast milk to nursing infants
- Through transplanted organs and blood transfusions
WHY DOES CONGENITAL CMV REMAIN LITTLE-KNOWN IN THE U.S.?
Six Possible Reasons
by Lisa Saunders
Six Possible Reasons
by Lisa Saunders
When told about CMV for the first time, some women dismiss CMV warnings from non-medical professionals and say, "If CMV was really a risk to my pregnancy, if I wasn't supposed to kiss my toddler around the mouth or consider not caring professionally for toddlers, my doctor would have told me."
The following are six reasons why most women have never heard of CMV:
1) CMV prevention education is not part of a doctor’s “standard of care.”
2) Low profile of congenital CMV: "hygienic practices do not appear to be widely discussed by healthcare providers and prospective mothers are often unaware of both CMV disease and the potential benefits of hygienic practices. The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed.” (“Washing our hands of the congenital cytomegalovirus disease epidemic,” Cannon and Finn Davis., 2005.)
3) Some doctors have cited the following reasons for not educating women about CMV:
5) Low media coverage about congenital CMV: In the article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?", Matt Shipman writes, “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity.” Media silence is a problem in regard to prevention, diagnosis and treatment (HealthNewsReview.org, 2018).
6) Child Care providers, though have an occupational risk for CMV, are not being told about CMV despite recommendation from the American Academy of Pediatrics et al., in Staff Education and Policies on Cytomegalovirus. This could be because there is no U.S. law regulating methods of CMV control in the child care setting. According to the Department of Labor, "Education and training requirements vary by setting, state, and employer." In most states, except Utah and Idaho, child care centers are not instructed to tell workers about CMV even though U.S. workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970).
What can be done to raise CMV awareness until prevention becomes a doctor's "Standard of Care"?
There are 562,420 child care workers in the U.S. (Dept. of Labor, 2017): “61 % of children under the age of 5 are cared for in a child care facility...Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.” (Thackeray and Magnusson, 2016). “Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018). “Parents of children attending day-care centers” are at increased risk for contracting CMV (Pass et al, 1986).
Not educating all women of childbearing age about CMV can be costly for everyone--and not just in heartache. The estimated cost of congenital CMV to the US health care system is “$1.86 billion annually, with a cost per child of more than $300,000” (Modlin et al., 2004).
December 27, 2022 update: Congratulations to Lisa Saunders on the passage of Elizabeth's Law in New York, USA! How a Baldwinsville mother fought for 30 years to pass a law that might have saved her daughter
The following are six reasons why most women have never heard of CMV:
1) CMV prevention education is not part of a doctor’s “standard of care.”
2) Low profile of congenital CMV: "hygienic practices do not appear to be widely discussed by healthcare providers and prospective mothers are often unaware of both CMV disease and the potential benefits of hygienic practices. The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed.” (“Washing our hands of the congenital cytomegalovirus disease epidemic,” Cannon and Finn Davis., 2005.)
3) Some doctors have cited the following reasons for not educating women about CMV:
- Don’t want to frighten their patients: "The list of things we're supposed to talk about during women's first visit could easily take two hours and scare them to death,” said OB-GYN Laura Riley, M.D., director of infectious disease at Massachusetts General Hospital in FitPregnancy magazine (June/July, 2008).
- According to the New York Times in 2016, "The American College of Obstetricians and Gynecologists [ACOG] used to encourage counseling for pregnant women on how to avoid CMV. But last year, the college reversed course, saying, ‘Patient instruction remains unproven as a method to reduce the risk of congenital CMV infection.’ Some experts argue that because there is no vaccine or proven treatment, there is no point in worrying expecting women about the virus...Guidelines from ACOG suggest that pregnant women will find CMV prevention 'impractical and burdensome,' especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission.” (“CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed,” Saint Louis, 2016).
5) Low media coverage about congenital CMV: In the article, "Why does CMV get so much less news coverage than Zika — despite causing far more birth defects?", Matt Shipman writes, “Researchers we spoke with identified the same factors – fear and the epidemic/endemic nature of the diseases – as driving the media disparity.” Media silence is a problem in regard to prevention, diagnosis and treatment (HealthNewsReview.org, 2018).
6) Child Care providers, though have an occupational risk for CMV, are not being told about CMV despite recommendation from the American Academy of Pediatrics et al., in Staff Education and Policies on Cytomegalovirus. This could be because there is no U.S. law regulating methods of CMV control in the child care setting. According to the Department of Labor, "Education and training requirements vary by setting, state, and employer." In most states, except Utah and Idaho, child care centers are not instructed to tell workers about CMV even though U.S. workers have the right to “receive information and training about hazards” (Occupational Safety and Health Act of 1970).
What can be done to raise CMV awareness until prevention becomes a doctor's "Standard of Care"?
There are 562,420 child care workers in the U.S. (Dept. of Labor, 2017): “61 % of children under the age of 5 are cared for in a child care facility...Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.” (Thackeray and Magnusson, 2016). “Almost all the babies that I see who have congenital CMV, there is an older toddler at home who is in daycare,” said Dr. Jason Brophy, a pediatric infectious disease specialist, in the Ottawa Citizen (Payne, 2018). “Parents of children attending day-care centers” are at increased risk for contracting CMV (Pass et al, 1986).
Not educating all women of childbearing age about CMV can be costly for everyone--and not just in heartache. The estimated cost of congenital CMV to the US health care system is “$1.86 billion annually, with a cost per child of more than $300,000” (Modlin et al., 2004).
December 27, 2022 update: Congratulations to Lisa Saunders on the passage of Elizabeth's Law in New York, USA! How a Baldwinsville mother fought for 30 years to pass a law that might have saved her daughter
Ways Various Countries Choose to Help Protect Unborn Babies from CMV
- “In Australia, state governments have differing recommendations for pregnant ECEC educators working with young children. Some states, such as Queensland, suggest relocating educators who are pregnant to care for children aged over two to reduce contact with urine and saliva” (Clark, 2019).
- In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016).